|
|
Fallon Clinic in the News
 |
 |
 |
 |
 |
 |
|
 |
|
|
 |
 |
By: Alice Dembner, Globe Staff
Date: June 22, 2004
With patients piling up in the waiting room and doctors struggling to provide good care during ever-shorter office visits, physicians are increasingly turning to an alternative: seeing patients in a group setting.
The shared medical appointment or group office visit, which typically lasts at least 90 minutes, allows the doctor and an assistant to provide individualized medical care with a dose of education and peer support to as many as 20 patients at a time. Nationally, doctors estimate that thousands of groups are underway, backed by such major institutions as the Department of Veterans Affairs and Dartmouth-Hitchcock Medical Center in New Hampshire.
In Massachusetts, doctors at Harvard Vanguard Medical Associates, Boston Medical Center, and several community health centers are among those offering groups, primarily for patients with chronic illnesses such as diabetes, arthritis, fertility problems, and lung disease.
Doctors' interest in the concept has taken off in the last three years, according to Dr. John Scott, a University of Colorado geriatrician who ran the first group in 1991 and has recently given how-to presentations at major medical conventions.
Patients who agree to the group format typically get quicker access to the doctor, more time with him or her, and a chance to learn how others are coping with an illness, according to doctors who offer the visits. Group patients retain the option of seeing the doctor privately for invasive procedures, exams requiring them to disrobe, or problems they don't want to share with others.
"Everyone recognizes that our health-care system is broken," said Ed Noffsinger, a health-care consultant who said he has helped start more than 300 groups since 1996. "This is one of the few ways doctors can be more efficient and patients get more care, not less."
In the late 1990s, two studies of geriatric patients with multiple illnesses who were randomly assigned to a group or to traditional office visits in Colorado found that patients in a group were far more satisfied with their care, were hospitalized up to 24 percent less often, and made up to 38 percent fewer visits to emergency rooms. A separate two-year study of diabetics in Italy published in 2001 found that those in the group kept their blood sugar virtually level, while blood sugar in the other patients rose an unhealthy 12 percent.
A recent session for diabetics at Fallon Clinic in Worcester, a large medical practice that is the local leader in group visits, suggests one reason for the positive results: motivation.
Attending for the first time, Sigismund Richardson of Auburn drew praise from Dr. Madeleine Fay for reducing his blood sugar without insulin. After listening as Fay discussed blood sugar levels with other patients, Richardson, 55, said he planned to work even harder at managing his illness.
"Everybody comes in with their results," he said in an interview after the group. "In three months, I want to come back and be better than the other guys."
In addition to Richardson, seven patients and two spouses gathered around a large table with Fay, an endocrinologist, and Leslie Bourne, a psychologist. The patients all signed privacy releases allowing discussion of their medical conditions. After a brief gripe session about living with diabetes, Fay began checking in with each patient.
Robert Bennett Jr., who like Richardson agreed to allow the Globe to write about his care, told Fay he had cut his carbohydrate intake and lost 6 pounds. With Bourne's help, Fay shifted into a discussion about why losing weight helps lower blood sugar, drawing quips from patients about ways to fight the urge to overeat. Then, Fay turned back to Bennett, who said he thought one of his medications was giving him the shakes. Fay decided to take him off the drug and then moved on to the patient sitting beside him.
"With a regular visit, you're in there for five minutes and then out the door," Bennett, 68, said later. "This way you get more information, and you pick up a lot of pointers from everyone else."
Doctors say they, too, find the groups satisfying.
"You get back to the doctor- patient relationship that you lose when you're running from office to office," said Scott, who has more patients interested in groups than he can accommodate. Some of his regulars, he said, claim the group is "better than live TV."
But the groups aren't for everyone. New patients almost always need individual appointments, doctors said. And patients with acute problems are often too sick to wait for the next group meeting.
Dr. Robert Yood, who runs rheumatology groups at Fallon, said many of his patients also flatly reject the option of shared appointments, horrified at discussing their private affairs in front of others. Others promise to come, but then don't show, sometimes leaving him with too few in the group for it to work efficiently. He and Fay each run two groups a month, with patients typically attending one every three months unless they get sicker.
Payments are also a stumbling block. While some insurers including Fallon Community Health Plan, Harvard Pilgrim Health Care, and Tufts Health Plan will pay for group visits, others, including Medicare and the state Medicaid program MassHealth, do not. (Medicare makes an exception for diabetes care.) Blue Cross and Blue Shield of Massachusetts does not cover group sessions, but spokeswoman Susan Leahy said it is reevaluating that policy.
Scott said doctors can legitimately get around those rules and bill for short office visits if they spend one-on-one time with each patient and keep careful records in the patients' charts. Many doctors who conduct shared visits also see group members individually in their private office for a few minutes after the group. Patients with insurance usually have to pay only a copayment.
Despite payment issues, more Massachusetts doctors are trying the shared appointments. Boston Medical Center's primary care practice is running 12 groups for diabetics and has a waiting list of about 50 patients, said Dr. Peter Davidson, who oversees the practice. Patients are showing better control of their diabetes, he said, and BMC plans to double the number of groups. The doctors are also considering groups for patients with high blood pressure and high cholesterol.
"It's partly for efficiency a provider can take care of 10 to 12 patients in an hour and a half but it's also for better education and better care of our patients," said Davidson, whose colleagues see four or five patients an hour in office visits.
Last year, Dr. Daniel Hoch, an epilepsy specialist at Massachusetts General Hospital, started a group in part to cut down on waiting times for appointments, which were often up to three months and which are a problem for many specialists in Boston. A high no-show rate led him to put the group on hold. But he wants to restart it as an ongoing group with a fixed membership, as opposed to the drop-in format he had used, which is common at Fallon.
Carol Morin came to Dr. Yood's rheumatology group at Fallon's Auburn offices earlier this month because of new pain in her shoulder and jaw. The North Oxford resident and other patients joked with Yood as they described their aches and discussed the pros and cons of medications. Yood palpated Morin's neck and prescribed a new drug during the first half-hour of the 90-minute group, but Morin stayed engaged until the end. Later, she said she always comes away with perspective, as well as treatment.
"It really, really helps when you're in pain to know there's always somebody in worse pain," she said.
top 
|
 |
|
|
|
|
|
|
|
|
|
|
|
|
|